Myelomeningocele (MMC) remains a severe neural tube defect that causes lifelong disability. In low-income and lower-middle-income countries (LMICs), including India, the burden is particularly high. A recent systematic review provides critical insights into Myelomeningocele surgical outcomes in these regions, emphasizing the gaps in preventative and therapeutic care.

Analyzing Myelomeningocele Surgical Outcomes in LMICs

The review identified 27 relevant studies involving 2,967 patients. Notably, the median age at surgery was 21 days. This delay is significant because international guidelines suggest closure within 48 hours. Consequently, the median overall complication rate reached 13%. Frequent postoperative issues included infection (16%) and CSF leakage (12%). Furthermore, the 10-year mortality rate was alarmingly high at 43%.

In India, the prevalence of neural tube defects remains a major concern. Current national policies for folic acid fortification are often under scrutiny. Some experts suggest that existing FSSAI standards are approximately 90% lower than WHO recommendations. Therefore, many children continue to be born with preventable defects. This data underscores the need for stronger public health interventions and timely surgical access.

Key Complications and Functional Status

Hydrocephalus is a frequent association, occurring in 64% of cases. Most patients underwent postnatal surgery because prenatal repair is largely unavailable in these settings. In addition to surgical risks, functional outcomes like ambulatory status and bladder function require long-term multidisciplinary care. Improving these outcomes necessitates earlier detection and intervention strategies.

Frequently Asked Questions

What are the most common complications after MMC surgery in LMICs?

Infection, cerebrospinal fluid (CSF) leakage, and wound dehiscence are the most frequent complications. These risks are often exacerbated by delayed surgical timing.

How does the timing of surgery affect MMC outcomes?

Delaying surgery beyond the first 48 hours significantly increases the risk of infection and neurological deterioration. In LMICs, the median delay is often 21 days due to resource constraints.

Is folic acid fortification effective in India?

While India has fortification policies, current levels may be insufficient. Strengthening these policies to meet WHO standards could prevent thousands of neural tube defect cases annually.

Disclaimer: This content is for informational and educational purposes only. It does not constitute medical advice or establish a doctor-patient relationship. Always seek the advice of a qualified healthcare provider for medical concerns. Refer to the latest local and national guidelines for clinical practice.

References

1. Muller R et al. Surgical management of myelomeningocele in low-income and lower-middle-income countries: a systematic review. J Neurosurg Pediatr. 2026 Apr 24. doi: 10.3171/2025.11.PEDS25319. PMID: 42030557.


2. Sinha A, et al. Food Fortification Ineffective in Preventing Neural Tube Defects in India due to Regulation Promoting Inadequate Levels of Folic Acid and Vitamin B12. Birth Defects Res. 2025 Jul;117(7):e2498.


3. Kancherla V, Oakley GP. The Unresolved Tragedy of Neural-Tube Defects in India. Indian J Med Res. 2022.